Journal of pediatric surgery
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Most retained esophageal foreign bodies (FB) are identified soon after ingestion and are easily extracted. A minority of FB ingestions are not identified for weeks to years and present significant problems for retrieval. The purpose of this study was to describe the diagnostic and therapeutic strategies needed to care for children who have chronic esophageal FBs. ⋯ Long-retained esophageal FBs are extremely morbid and life threatening. History most often identifies excess salivation, new onset asthma, and/or recurrent upper respiratory infections. Three diagnostic adjuncts are helpful in identifying the presence of a long retained FB: (1) Chest x-ray (PA and lateral), (2) barium swallow, and (3) esophagoscopy. Indications for thoracotomy for removal of foreign body include (1) Poor endoscopic visualization of FB because of inflammatory tissue and (2) Herald bleeding during endoscopy.
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Cardiopulmonary resuscitation (CPR) is reported to be used in a significant number of neonates before initiation of extracorporeal membrane oxygenation (ECMO). This report establishes the incidence of infants who require CPR before initiation of ECMO and elucidates survival rates and long-term neurological outcomes. In addition, the authors sought prognostic factors that could reliably predict survival or long-term neurological outcome before initiating ECMO support. ⋯ A survival rate of 60.8% with good neurological outcome at 12 months in 63.4% of infants suggests that CPR alone should not be a contraindication to placing a neonate on ECMO.
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The authors present a 3-year-old girl in whom severe hyperphosphatemia and hypocalcemia developed after the administration of three adult-sized hypertonic phosphate enemas. The commonly held notion that these enemas are not absorbed and therefore are systemically inactive is incorrect. ⋯ The treatment of hyperphosphatemia is reviewed as well as underlying pathology such as altered gastrointestinal motility and renal insufficiency, which may predispose the patient to this problem. Physicians should be aware of the possible adverse effects that can be caused by hypertonic phosphate enemas.
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Despite recent advances in the management of high-risk congenital diaphragmatic hernia (CDH), mortality remains high. Deaths occur later because infants with inadequate pulmonary parenchyma are treated aggressively but eventually succumb to respiratory failure. In an attempt to identify absolute predictors of mortality the authors examined retrospectively their experience with CDH to determine if cardiac arrest before repair or initiation of extracorporeal membrane oxygenation (ECMO) invariably increased mortality. ⋯ CA cases were more likely to require ECMO support (76% v 48%, P = .02) and to stay on ECMO for a more prolonged period than NCA cases (5.8 v 3.8 days, P = NS). However, there was no significant difference in overall survival between CA and NCA cases (43% v 51%, P = NS). Cardiopulmonary arrest before repair of CDH or ECMO cannulation is not a univariate independent predictor of mortality and therefore should not preclude these high-risk infants from maximum intensive care therapy, including ECMO cannulation.
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Multicenter Study
Firearm injury among urban youth during the last decade: an escalation in violence.
To better characterize firearm violence in urban youth, the authors investigated the circumstances and outcome of shootings among youths under 17 years of age. ⋯ The incidence of gunshot wounds in the youth of this urban population has increased substantially over the past decade. Adolescent black boys were the most frequent victims of these shootings. There has been a disproportionate growth in violent circumstances surrounding the shootings.